1921: The Children's Ward at National Jewish Hospital

Figure 1 -- Hofheimer Children's Building

National Jewish Hospital for Consumptives got off to a great start. In fact, it got off to such an impressive start that after WWI it was noted a need for expansion.  In 1920 a new ward was completed and designed specifically for children. It was called Hofheimer Children's Building (figure 1).

What this showed was the stunning success of the sanatorium for patients with consumption.  During the 1840s George Bodington opened the first sanatorium in Sutton, England.  After publishing his research his opinions were rejected, and his research abandoned.

In 1854 Herman Brehmer picked up his research and opened a sanatorium in 1859 at Goerbersdorf in Prussian Siselia.  It was his research that proved the value of open air treatment and good hygiene in the treatment of consumption.

In 1884 Edward L. Trudeau tested Brehmer's methods in America.  A small amount of money, a small amount of land, and two small buildings were donated.  The Trudeau sanatorium was a success, and provided an example for many other future sanatoriums opened in the United States, including National Jewish in Denver.

Figure 2 -- Rear view of the Hofheimer Children's Building

In 1899 National Jewish Hospital for Consumptives opened, and the specific goal was to provide help only for those who were unable to pay.  Some of the over 300 patients who submitted applications in the first three years were rejected due to the fact they had family members willing to pay for their medical support.

By 1921 it was considered one of the finest sanatoriums in the United States.  Considering that Consumption was among the leading causes of death at this time, of the 3,613 patients seen at National Jewish since 1900, 50 percent returned to their previous occupations once discharged.

Figure 3 -- Combination diet kitchen, drug station, and chart room

The hospital started out as one building and grew to eleven, and the sanatorium had access to a seventy acre farm to furnish a fresh supply of milk and eggs.  A new Children's building was compliments of Mrs. Nathan Hofheimer of New York.

Previously the care of children was done in various locations in the other buildings, and this new building will therefore create a great advancement for the children.  It will provide better access to preventative treatment of consumptive children whose families have no means of affording treatment for them.  The new building has two stories, a basement, and can hold up to 35 children.

Figure 4 -- The girls dormitory.  Notice the arrangement of chairs
and beds to absorb sun rays.

A detailed description of the building is as follows:

On the.first floor is a reception room, a dining and play room for the children, a diet kitchen, dormitories for sixteen beds, with adjacent dressing rooms, bath rooms, toilets, linen room and pantry, and a large porch, fourteen by twenty-five feet, in which it is contemplated to apply heliotherapy. On the second floor are dormitories for sixteen beds, with adjacent dressing rooms and bath rooms, two private rooms with a private bath

The goal of the new facility is to...

Figure 5 -- A list of states and how many patients came from those states.

"establish a preventorium for children who would otherwise live in an environment that would render them susceptible to tuberculosis. They may be sent here for a variable period to be built up by the natural agents of fresh air, good food, and adequate rest, and made strong enough to hold their own in the social complex of city life. In addition it is intended to care for a certain number of orthopedic  cases in this building. There are ample facilities in the Grabfelder Medical Building of the hospital to offer every diagnostic and therapeutic agent that a case may call for. In this building, which is adjacent to the children's building, there are complete facilities for all laboratory, roentgenological, and fluoroscopic examinations, in addition to special dental and nose and throat clinics."

The daily routine of the children seems to be quite similar to when I attended the hospital in 1985 (although when I attended this building sat across from the main complex empty).  Without the ability to interview the caregivers nor the patients, it's nearly impossible to do justice, although the following is a gallant attempt.

1.  Each child is examined fully, upon admittance, and thereafter at regular periods to determine its progress.

2.  The medical care of the children is under the immediate supervision of specialists in orthopedics, pediatrics, and tuberculosis. 

3.  The diets and routine life of the children are under the supervision of a competent person.

4.  The following is the basis of the routine life of the children: 

• 6:45-7:30, daily shower and dress;
• 7:30-8:00, breakfast; 
• 8:00-8:45, housework; 
• 8:45-12:00, school; 
• 12:00-1:00, dinner; 
• 1:00-3:00, rest hour; 
• 3:00-5:00, recreation and occupational therapy; 
• 5:00-5:30, supper; 
• 5:30-7:15, recreation or study period.

5.  The children attend school three hours every morning and their work is conducted by an approved public school teacher. The program corresponds as nearly as possible to that used in the city grammar schools and it is planned to accomplish one semester of work in a year. 

6.  The department of occupational therapy provides tent specialist. The children are trained to be nimble with their fingers, quick with their eyes, and original in ideas. 

Figure 6: Plan of the 2nd floor of the children's building. On the backside
of the building are the dormatories, women on left, men on right.

7.  The following crafts are chiefly used: 

• basketry, 
• leather tooling,
• painting, 
• toy making, 
• elementary book binding, 
• weaving 
• and block printing. 

Perhaps occupational therapy was as essential to the tuberculosis child in 1920 as the asthmatics admitted to the hospital in 1985.  These children grow up with diseases, often have trouble breathing, and are often forced to forgo some of the normal activities of healthy children.  For this reason they generally lag behind in basic skills, and this can erode self confidence.  

Figure 7 -- Layout of 1st floor. Dormitories on back side. There are
plenty of windows so allow in plenty of sunlight.

The following further explains this:

"Children living in an institution are necessarily barred from many of the interests of the normal child, and the tendency is to develop habits of idleness and carelessness. Occupational work to a large extent corrects this evil and is frequently responsible for the development of a latent talent. In many cases these crafts lead directly into vocational training along some original line. Whether or not these crafts are used as a means of livelihood in the future, they at least furnish a possible avocation, and in some measure care for those hours which otherwise may easily undo the years of preventive care. Part of the function of a preventorium is to furnish content of mind through active hands, and thus lay the foundations for a useful, busy life no matter what the physical handicap may be. An appreciation of beauty, and the ability to transform that appreciation into some concrete form is a never failing source of interest and pleasure to a child, and he rapidly becomes skillful enough to make objects of real value."

I think the following sums this service up well:

"In this manner, with the generous aid of our numerous friends, we are the agency that takes little children from the slums and tenement districts where frequently we'find them pale, anemic, undernourished, and undersized, sometimes with a. dulled mentality, and gives them the things that are theirs by birthright, fresh air, wholesome food, adequate rest, and wholesome ideas. In a remarkably short time the pale cheeks take on a rosy color, the dull listless eyes become bright, the child with a backward air begins to laugh heartily, and the undersized child takes on weight. Thus in about a year’s time the child is ready to return to the life of the city, but now he is prepared to survive in the struggle."

So the staff at the facility does more than just get the children healthier.  They also work hard to teach them about their disease and provide them with the skills and confidence tofunction in the real world.

Prior to discharge the homes the patient will be returning to are inspected to assure they will provide for the safe and therapeutic environment the patients are instructed in.  The homes must provide cleanliness, good hygiene, and fresh air.

Plus, I would imagine, the family, particularly the mom and dad, must be educated about the disease and the importance of good hygiene.  They must also provide the necessary care and encouragement, and be able to notice the signs of worsening health.

Based on my own personal experience, I think among the most important therapies provided by such a facility isn't so much educating the child, but the family.  Although this, I think, is the most challenging part

According to NationalJewish.org, the Hofheimer Preventorium was open until 1941, and in its 23 year history cared for 730 children.  

References:

1. Prisko, S., Secretary for NJH Hospital for Consumptives, "The New Children's Building of the National Jewish Hospital for Consumptives," The Modern Hospital, Volume XVI, No. 5, January to June, 1921, pages 404-407.  All the material in this post that is not my own comes from this reference.  It was a great article, and provides a great description of life at NJH.

1899: National Jewish Hospital for Consumptives

Figure 1 -- National Jewish Health for Consumptives (5, page 16)

By the 1880's a whopping 25% of Denver's residents were suffering from lung diseases -- mainly tuberculosis, and many were literally dying in the streets.  This inspired the Jewish community to coalesce and donate funds to build a home for them. 

In 1899 the doors to the National Jewish Hospital for Consumptives opened with the motto  (1): 

"None may enter who can pay -- none can pay who enter."  

It was built by the Jewish Community, and it was funded mainly with the financial assistance of the International Order of B'nai B'rith. The hospital "adopted a program that emphasized the benefits of fresh air, good nutrition and rest." (6)

Figure 2 -- Patients at National Jewish Hospital getting sun treatment

Regardless of where the funds came from, anyone was allowed to enter who needed help, so long as they couldn't afford to attend one of other sanatoriums.  (2)

The following rules were listed for those desiring admission: 

"The National Jewish Hospital for Consumptives at Denver is intended for the treatment of tubercular diseases only, among the indigent, in whom the disease is not sufficiently advanced to preclude the possibility of recovery or the arrest of the disease within the time, assigned for the treatment." (3, page 156)

Figure 3 -- National Jewish Hospital circa 1920s

The neat thing about the hospital is the it was under the control of a National Board of Directors consisting of 35 members from principle cities around the United States.  When a patient wanted to be admitted, he'd have to have the endorsement of the local director, plus "be examined by a properly authorized physician of the city in which he lives." (3, page 156)

The examination form and the application were then submitted to the"Denver Board for action. Upon arrival in Denver, he (the patient) is at once admitted to the hospital, and re-examined by the admitting physician." The patients are then examined on a weekly basis. (3, page 156)

Compliments of National Jewish Health Facebook Page. 

322) and accepted both male and female patients of all ages. Patients may be married or single. Patients were generally admitted for six months, and examined every two months by their general physician.  Patients could stay longer than six months per recommendation by the medial advisory board.  No patient could stay longer than one full year.
The hospital had a capacity for up to 65 patients, (4, page

The patients in the first three years admitted were of a variety of occupations, including six school children, many tailors, salesmen, and clerks.  Eight were cigar makers, and many more were laborers or worked in sweat shops in New York and Chicago.  (3, page 157)

Compliments of National Jewish Health Facebook Page. 

Of these patients, 83% were admitted after an exacerbation caused by a cold picked up at work. Thus it was based on these statistics that poor hygiene was blamed for many cases, and hygienic rules for certain occupations, particularly tailors and sweat ships, were recommended to and passed by the New York Legislature.  (3, page 157)

Once a patient is admitted treatment is based on a per patient assessment, with one of the more common treatments being open air treatment.  For this reason many of the rooms are made so that they have windows for absorbing sun rays.  Patients have their sputum assessed upon admission and discharge, and weekly.  Patients are also weighed weekly.  (3, page 156)

Other treatments include:

"The climate, nutritious food, and personal hygiene, were mainly relied upon. Patients are encouraged to keep out of doors as much as possible, and to further this purpose, games are provided for their amusement, upon the porches and grounds surrounding the hospital. The food provided is the best the market affords, and is properly prepared. There are a number of special diets upon which the patients may be placed, as directed by the attending physicians, besides numerous extras, which may be ordered for the patients. It has been the aim of the staff to give particular attention to the quality and preparation of the food provided for the patients, and in this it has found the ready cooperation of the Board of Managers.

"All patients are instructed in the danger that lies in communicating the disease through the sputa, and paper spit-boxes are provided for them, which they are required to carry with them in and around the hospital. They are not allowed to expectorate in or use handkerchiefs. Pieces of cheese-cloth, which can be cremated, are provided for their use. Various other measures to secure personal cleanliness are enforced. In regard to medication, no systematic attempt has as yet been made to use true specific medicines. Patients are treated symptomatically, and the majority of the attending physicians avoid the use of large numbers of drugs." (3, page 158)

When the hospital was first opened any patient with consumption was admitted, but this resulted in a high number of deaths in the first year.  This also  resulted in a tightening up of the admitting rules.  After the initial year, "only those in the early stages of pulmonary tuberculosis, who are likely, in the opinion of the admitting physician, to be improved by hospital treatment, have been admitted." (3, page 156)

Figure 4 -- National Jewish Hospital today

According to the Denver Chamber of Commerce, by 1912, it is reported that about 75 percent of consumptive patients staying at the hospital benefit from the treatment provided. Of that 75 percent, up to 25 percent "regain permanent health." (5, page 16)

The Chamber advertised the hospital as benefiting consumptives due to the...

"high, dry altitude, with the maximum of sunshine, is the great remedial agent goes without saying. Situated one mile above sea level, protected by the Rocky Mountain range from cold winds in a latitude nearly parallel with Washington, D. C, Denver and vicinity offers almost unequalled attractions to the invalid; more specially those suffering from lung and throat trouble. The summers are delightful, hot in midday, but with remarkablv cool nights, and always cool in the shade, even in midday. Sunstroke is a thing never known, because of the dryness of the air. There is no dewfall at night; therefore, one can live out of doors in comfort all through the season from May 15th to October 15th. Indeed many invalids live in tents in winter as well as summer." (5, page 16)

Figure 5--
National Jewish wasn't the only tuberculosis sanatorium in Denver.
There were many others in the area, some of which were tent farms.
Tent farms were preferred by some because they were less expensive.
Plus, many also allowed accommodations for "invalids,"
or those victims in the end stages of disease. (5, page 16)
There were many others located around the U.S. and Europe.
Pictured here is the Nordach Sanatorium,
Austin Bluffs, Colorado in 1906
Compliments of Wikepedia. 

As I sit here typing this up I wonder how helpful these sanatoriums were at treating lung diseases, considering the limitations of the era. However, I would imagine they offered solace to those victims of lung diseases who otherwise had little or no home, and especially those who were weak and disabled and left to the streets.

While it was not the only sanatorium in Denver, let alone the west, what made National Jewish stand out were efforts in 1914 to open the first building outside a university with the specific goal of researching a cure for disease.

It was also special for opening a ward during the 1920's specifically for children suffering from lung diseases. By the 1930's the hospital had the capacity to hold hundreds of children of all ages with a disease called tuberculosis. So, this made it one of the few such institutions to provide a home and hope for people of all ages suffering from tuberculosis. By this time it was also a leader in its attempts to find better treatment and a cure for tuberculosis and other lung diseases that plagued society at the time.

References:

1. Gurock, Jeffrey S., ed., "American Jewish History," 1998, New York, vol. 3, part 3, pages 1095-6
2. "The History of National Jewish," NationalJewish.org, http://www.nationaljewish.org/about/whynjh/history/
3. Saling, Simon, "Report of Cases Examined for the National Jewish Hospital for Consumptives, at Denver, Colorado," The Philadelphia Medical Journal, July 27, 1901, Volume III, July to December, 1901, Philadelphia, The Philadelphia Medical Publishing Company, page 156
4. Solis-Colon, Solomon, "A system of physiologic therapeutics," volume IV, Book II, 1901, Philadelphia, P. blakiston
5. "Denver and Vicinity as a Health Resort," Denver Today: Denver Chamber of Commerce, 1912, Denver, Colorado, Compiled and Published by the Denver Chamber of Commerce
6. "National Jewish Hospital for Consumptives, University of Denver, Special Collections & Archives (Beck Archives), 
7. another good reference

1800-1900: The birth of the TB sanatorium

La Miseria by Cristóbal Rojas (1886) depicts TB late 19th century

By the mid 19th century it was well known that if you were diagnosed with tuberculosis, there was an 80 percent chance you were going to die.  So the outlook for those infested was bleak.

To make matters worse, tuberculosis was a serious threat to society at this time, making it a well known malady and a well known killer.  People had a very pessimistic view of it, and often became submissive to it thinking it was the will of God.

From about the mid 19th century to the turn of the 20th century it was the leading cause of death.  Most every family had either a family member or knew of someone who had the disease or had died from it.

By the end of the industrialized revolution, or by the end of the 19th century, over seven million people had been inflicted by the disease, and at least 50 percent of the populace in America and Europe had been directly impacted by it.  The hardest hit areas were highly populated areas like New York and London.  At the turn of the century it was estimated that over seven million people were dying from the diease yearly.  (12, page 14)

It was a common killer yet people knew so little about it.  They had no idea that overcrowding and poor sanitation was a significant reason for it's spread.  They had little knowledge that it was spread by droplets in the air breathed.  Humid and poorly ventilated rooms created great breeding grounds for Micobacterium Tuberculosis.

Carl von Rokitansky of Vienna (1804-1878) performed many autopsies on tuberculosis victims, and studied the tissue of organs of many who survived.  He learned that of those who survived up to 90 percent had "tuberculous lesions within the normal tissue of the lung."  (1)

Hermann Brehmer (1826-1889) was diagnosed with the condition while he was a botany student in the late 1840s, and he was told my his doctor that he might benefit from the clean air of the Himalayas.  So journeyed there to study plants, and by 1854 her returned to Germany with a new mission to study medicine and ultimately learn more about consumption.

He aimed to add on to the works of Rokitansky.  He described that not all people die from the disease, that many develop "healing of the tubercles in the form of scar formation, calcification, and adhesions, before disintegration and destruction of the lung tissue with its accompanying harmful effect on the whole organism had set in," according to Hugh M. Kinghorn in his paper aptly titled "Hermann Brehmer." (1) 

He wrote a paper "Tuberculosis is a curable disease," in which he was adamant that consumption was a curable disease.  He recommended those inflicted with the condition eat well, get plenty of rest, and exercise.  He was also the first to recommend isolation of those infected both so the victims could receive the proper treatment he recommended, but also to prevent contamination of healthy people.

While he would fight his entire life to convince the medical community that his ideas and treatment for consumption were on the right track, he was the only one to have any success in treating the Great White Plague in Europe during the 19th century.

Yet it took a little luck and some hard work to get his project going.  In 1849 the eldest sister of Brehmer's first wife, Marie V. Colomb, established a hydrotherapy institution in Gorbesdorf, which is a village in Silesia, Germany.  Yet her venture failed, and Brehmer took advantage of this and set up his sanatorium to prove he was right about tuberculosis.

Originally he ran into many problems.  He initially had only a few patients, one cow, and "and a lean horse to fetch coal from a distant place and patients from the station."  Yet after a few years he started to show success, and other physicians started sending him patients. 

Because he houses were private and he was having problems with the natives, he decided to build a "kurhaus" of forty rooms, an entertainment room and several kitchens.  This project was finished in 1862, and ultimately more rooms were added so it could house 60 patients. 

His project proved so successful that soon sanatoriums were being build in mountainous areas all over Europe and the United States.  One famous one in the United States was built in Denver, Colorado in 1899 by the Jewish Community. (See references 5 and 6 for more on this)

In 1895 a German by the name of Wilhelm Konrad von Roentgen discovered the x-ray that allowed doctors to see the disease in its early as well as it's late stages.  This marked the first time that the disease could be diagnosed in its early stages instead of having to wait to see the late signs.  It also allowed doctors to see the tubercles in those who had survived the disease.  It showed both active and inactive tuberculosis.

The bacillus that causes consumption was first seen by Robert Koch under the keen eye of the microscope in 1882.  Koch attempted to find a cure and at one point thought he found it, yet he ended up being wrong and was ridiculed for his mistake.  He continued his work for a while, yet later gave it up to work in other areas.  (3) Yet he was so close, and may have succeeded if he just continued a little longer.

Yet another mistake made by Koch was that he joined forced with the German Government to market what he said was a cure.  Many TB patients rushed to Germany to receive his new treatment, and over two thousand TB patients received his remedy.  Yet many of these patients got worse, and faster.  Koch later admitted his remedy was only an extract of the tubercle bacilli. (7, page 17)

In 1907 Clemons von Pirquet proved a tiny scratch of tuberculin was enough to prove a sensitivity to it.  It was from this work, and the work of Koch, that in 1907 Charles Mantoux discovered the first technique to test for tuberculosis.  It became known as the Mantoux test, or the TB test.  It was modified in the 1930s so that it was able to be mass produced, and since then the test has been available.  Most people in the western world have had this little prick more than once.  (3)

However, by the end of the 19th century and the early 20th century sanatoriums for tuberculosis victims were popping up all over the place.

In 1900 tuberculosis was the leading killer in the United States, yet soon thereafter deaths from TB started to decline.  Success in battling TB is often attributed to improved living conditions, reduced crowding, improved sanitation, proper nutrition and isolation.  The sanatoriums probably helped in this regard, yet they also allowed those infected to get proper treatment. (4)

Cases of Tuberculosis have consistently declined in the United States and Europe so that the disease was actually believed to be extinguished in in western societies during the 1980s.  Yet recently some cases have been reported, and these were probably cases contracted while someone was traveling abroad to a third world nation.  TB continues to be a problem in many nations, particularly where sanitation and crowding continue to be a problem.

To make sure the disease remains rare in technologically advanced nations like the U.S., Europe and Australia, most people are tested yearly for the disease.  Most hospitals, mine included, make the test mandatory.

References: 

1. Kinghorn, Hugh M, "Hermann Brehmer," Trans Am Climatol Clin Assoc., 1921; 37: 193–210.
2. Warren, Peter, "The Evoluiton of the Sanitorium: The First Half-Century, 1854-1904
3. Shashidhara, A.N., K. Chaudhuri, "The Tuberculin Skin Test," The National Tuberculosis Institute, 1990, vol. 26, 1&2, March and June
4. Vynnycky, E., PEM Fine, "Interpreting the decline of tuberculosis: the role of secular trends in effective contact," International Journal of Epidemiology, 1999; 28; 327-334
5. Gurock, Jeffrey S., ed., "American Jewish History," 1998, New York, vol. 3, part 3, pages 1095-6
6. "The History of National Jewish," NationalJewish.org, http://www.nationaljewish.org/about/whynjh/history/
7. "The Captain of the Men of Death," Ulster Medical Journal, 1989, (Suppl): 7-9
8. Landau, Elaine, "Tuberculosis," 1995, New York, Chicago, London, Sydney, Franklin Watts, pages 13-32

900-1300: The Soporific Sponge

Physicians at the School of Salerno in the 15th century are believed to be the first to provide anesthetics during surgery.  The method used was to turn a simple sponge into an inhaler, what surgeons referred to as the "soporific sponge," according to historian Garrison Fielding Hudson. (1, page 142)

Hudson said that "surgical sleeping draughts" are referred to as the "soporiphic sponge" as early as the 11th century in "the beautiful Jenson imprint of the Antidotarium of Nicholas of Salerna that was published in Venice in 1471.  (1, page 142)

This was a sponge that was "steeped in a mixture of opium, hyoscyamus, mulberry juice, lettuce, hemlock, mandragora and ivy, dried, and, when moistened, inhaled by the patient, who was subsequently awakened by applying fennel-juice to the nostrils." (1, page 142)

This "prescription" was believed to be derived from earlier treatments of "anodyne applications" used to treat insomnia at the temples of the Aesclepius by the Ancient Greeks and Romans.  Later on Mandragora became "preferable to opium and hemlock."  (1, page 142)

Could you imagine the stress that a physician wanted to give you such a medicine in an age when it was still greatly feared to be operated on?  This type of fear was noted in a poem in Marlowe's Jew of Malta: (3, page 143)

"I drank of poppy and cold mandrake juice. And being asleep, belike they thought me dead." (3, page 143)

So the anesthetic may have been taken internally by some, yet it was due to this fear that the anesthetic was not taken "internally by Salernitan physicians."  I think this was a wise decision, and this made the "Soporific Sponge" a wise alternative.

The"Soporific Sponge" is an early, yet primitive, example of one of the first uses of an inhaling device. It is for this reason I mention it here.

It is also surmised that the Salerno medical community greatly influenced Arabic medicine. (1, page 187)

Yet, ultimately, Arabic medicine would grow so that it superseded the old Greek traditions taught at Salerno, and this is believed to be what caused the fall of Salerno from its "high estate."  (1, page 187)

The School of Salerno met its demise sometime in the middle of the 13th century.(1, page 187)

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company

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1483: The King uses his allergies to kill Lord Hastings

Figure 3 -- King Richard III (1452-1485)

Legend has it that King Richard III (1452-1485) knew he had an allergy to strawberries, and in 1483 he used this wisdom to kill his arch enemy, Lord William Hastings. (2, page 4)

The King purposely ate some strawberries and blamed his allergic reaction on a curse from Lord Hastings. For his punishment Lord Hastings was beheaded, and his head was served on a platter. (2, page 4)

The king was able to get away with this because nobody knew about allergies other than those who suffered from them.  Other than the king, most allergy sufferers were hard working men and women who had little time to let minor suffering slow them down.

And even when they did report their symptoms to physicians, they were generally brushed off as something minor, like a cold. Physicians had better things to worry about, such as deadly plagues.

References:

1. Cantani, "Pediatric Allergy, Asthma and Immunology," 2000, New York, page 724
2. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008

1316: Mundinus publishes book of anatomy

Figure 1 -- Title page of Mundinus:
 "Anathomia," Leipzig, 1493
(1, page 151)

So we know that the School of Salerno was a great medical institution from the 10th to 13th centuries, and physicians from all over the world flocked there to get the best medical instruction.  Yet most historians will acknowledge that while it was a great learning place, there were few medical advancements made there. 

One of the great exceptions occurred in 1316 when Mundino de'Luzzi, or Mundinus of Bologna (1270-1326), who wrote a book called "Anathomia," which translates to "Dissection."  Still, while he wrote it while teaching at Salerno, it was first published until 1487 at Padua, and 1493 at Leipzig by Martin Pollich-von Mellerstadt. (see figure 1) (1, page 150-151)

Mundino was professor of medicine and anatomy at the University of Bologna, and he was one of the few physicians "to turn his eyes from the pages of Galen to the book of nature, and to learn for himself, by actual dissection of the human body, how this body was constituted." (5, page 199)

It was, therefore, from his own observations that he compiled his book.  (4, page 199)

The book was basically an account of how to perform an autopsy beginning with the abdominal cavity, which contains the perishable viscera, and then moving to the chest, where he provides a description of the heart, and to the skull where he describes opening it.  (4, page 376) (1, page 150-151)

However, because of the dogmatic nature of the Church, he was not able to sway far from the teachings of Galen, said D. Kerfoot Shute in 1910.  "The all-powerful Church still taught the sacredness and the inviolability of the human corpse and was alert and ready to punish as a sacrilege the use of the anatomist's scalpel; and what Mundinus did was done in the face of this powerful opposition." (5, page 199)

Perhaps this is why Garrison said:

In intention, this work was really a little horn-book of dissecting, rather than a formal treaties on gross anatomy.  (1, page 150)

He said the book was full of...

...Galanic errors in regard to the structure of the human frame, preserving the old fictive anatomy of the Arabists, with the Arabic terms, this book was yet the sole textbook on anatomy for over a hundred years in all the Medieval schools." (1)

The book would be the "universal textbook" of anatomical dissection for the next 200 years at all medieval schools, passing through "39 separate editions and translations." (4, page 376) (1, page 151)

His work was continued by his pupil Niccolo' Bertuccio (died 1347), said Garrison.  He said:  "After this time, dissecting gained a firmer foothold as a mode of instruction." (1, page 151)

However, Shute said that, perhaps due to the opposition of the Church, "Mundinus had no disciples carry on his work.  All that remained of him was his very inadequate book which was used in schools merely as an introduction or help to Galen.  At best he became little more than a later and smaller Galen." (5, page 199)

While there were little or no advancements in medicine as a result of his book, it helped to preserve medicine during the dark ages of medicine.  It would be over 200 years after Mundinus (at the beginning of the 16th century) that the Church would finally start to lose its grip and influence over medcine.   (5, page 199)

Jacobus Berengarius da Capri, who lived from 1460-1530, was an Italian physician who continued the work of Mundinus.  Shute said:

But he had his struggles with the church. He was driven to desert Bologno, where he had long been a teacher, and to live in exile in Ferrara.

Yet this was a time when the Church learned to appreciate anatomy, although trough paintings more so than medicine.  Shute said

In the sixteenth century the ruling powers of the church not only sanctioned but even favored the pursuit of that branch of anatomy which is indispensable to sculpture and painters. In 1525 Albert Durer published a work illustrating the symmetry of the body—but as an artist and not anatomist. Under the protection of the Popes, Julius II and Leo X, Leonardo da Vinci, Michael Angelo, and Raphael copied from nature the superficial muscles. (5, page 199)

This was the state medicine was in when two of the most significant figures in our medical history were born: Jacobus Sylvius and Andreas Vessalius.

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
2. The John Hopkins Hospital bulleton," (volume XV 1904), "from the epoch of the Alexandria School (300 B.C.)"
3. "The Ancient Medical School of Salerno," associazioneermes.it, http://www.associazioneermes.it/MedicalSchoolSalerno.htm, accessed 12/4/12
4. Frampton, Michael, "Embodiments of Will: Anatomical and Physiological Theories of Voluntary Animal Motion from Greek Antiquity to the Latin Middle Ages, 400 B.C. - A.D. 1300," 2009, Berlin, VDG Verlag
5. Shute, D. Kerfoot, "The life and works of ndreas Vesalius," Old dominion journal of medicine and surgery, Tomkin, Beverly R. Tucker, Douglas Vanderhoof, Murat Willis, R.H. Wright, editors, 1910, Richmond Virginia, The Old Dominion Publishing Corporation, pages 195-211

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1281-1348: Xi defines asthma for China

InZhu Dan Xi (1281-1348)

The next person to make a significant impact on the "flow" of asthma wisdom through Ancient China was InZhu Dan Xi (also known as Zhu Zhenheng). 

He lived from 1281-1348 A.D, and was born to a medical family.  He believed his family received poor medical care when he was young, and therefore became determined to learn about medicine.  (1)

He believed over indulgence depleted the essence of yin and caused chronic diseases.  His most significant recommendation was temperance. (2)

He continued to describe diseases as an imbalance of the humors as was described in the Nei Ching some 2,000 years earlier, and as described in Ancient Egypt and Western Civilizations.

Xi is often regarded as the first Chinese physician to provide a modern description of asthma. He combined chuan and Xiao to come up with chuan xiao, which many historians believe is similar to the Western world's description of asthma. (3, page 41)

From this time on Chinese physicians believed Chuan xiao was caused by an imbalance of yin and yang, which are polar opposites, and "obstruction to the flow of Qi by phlegm in the airways, said asthma historian Mark Jackson.

Ma Huang continued to be a common therapy for the treatment of any respiratory ailments along with "Qi supporting" liquorice and gypsum decoction, "Yin syndrome asthma was treated with Yin Returning elixer."  (3, page 41)

Since Ma Huang was a much better bronchodilator than any western treatment for asthma, Chinese asthmatics had it at least a little better off than their contemporaries in the rest of the world, or so one might imagine.

References:  

1. Beijing Medical Museum of TCM
2. "Chu Tan-chi [Zhu Danxi/Zhu Zhenheng; 1280-1358 A.D.," Chinese Medicine History,  http://www.taijichinesemedicine.com/zhudanxi.htm
3. Jackson, Mark, "Asthma: The Biography," 1998, New York, page 41

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